Candida and Oral Candidosis—A Review

Abstract

Oral candidiasis (also called candidosis) is an opportunistic infection affecting the oral mucosa. These lesions are very common and caused by yeast Candida albicans. C. albicans are normal component of oral microflora and around 30 to 50% carry these organisms. The rate of carriage increases with advancing age of the patient. C. albicans are recovered from patient’s mouth over the age of 60 years. Other species such as C. glabrata, C. tropicalis, C. guilliermondii, and C. krusei are infrequently but consistently isolated. Oral candidosis can be classified into primary and secondary candidiasis. The factors involved in the pathogenicity of C. albicans have been reviewed. The pathogenesis of different biotypes and strains of C. albicans varies. A relationship has been suggested between the adherence of C. albicans to surfaces and its ability to colonize and cause disease. An important aspect of the pathogenicity of C. albicans may be its nonspecific affinity and binding to acrylic resin and other plastics. The factors affecting adhesion of yeasts, related to yeast cells, related to host cells and environmental factors, and the main factors which increase the susceptibility of oral candidiasis have been reviewed. The different types of oral lesions, their identification by different methods, management, and treatment of oral candidiasis also have been highlighted.

Oral candidosis as a common opportunistic infection has gained importance after the discovery of human immunodeficiency virus infection. Candidiasis was always an endogenous infection. There are few cases of exogenous infection in intravenous drug abusers and contact lens users. Esophageal candidiasis is the earliest and most cases of lesions seen in acquired immunodeficiency syndrome patient. The diagnosis and reporting of oral candidiasis should be done with utmost care. The finding of yeast cells in large numbers and presence of pseudohyphae indicate invasion and causative agent of infection. The diagnosis of Candida infection can be confirmed by various techniques and recently discovered advanced methods.

The confirmation of Candida infection depends on clinical diagnosis, proper collection of specimen, and careful evaluation in methodology and reporting.

Keywords

Candida albicans - oral candidiasis - microflora

Publication History

Received: 15 January 2019

Accepted: 15 February 2019

Article published online:
10 February 2020

• References

• 1 Terezhalmy GT, Huber MA. Oropharyngeal candidiasis: etiology, epidemiology, clinical manifestations, diagnosis, and treatment. Crest Oral-B at dentalcare.com Contin Educ course 2011; 1-16
• 2 Prasanna KR. Oral candidiasis-a review. Scholarly J Int 2012; 2: 6-30
• 3 Dangi YS, Soni ML, Namdeo KP. Oral candidiasis, a review. Int J Pharma Pharma Sci 2010; 2: 36-41
• 4 Parihar S. Oral candidiasis- a review Webmed Central. Dentistry 2011; 2 (11) 1-18
• 5 Mandell GL, Bennett JE, Dolin R. Anti-Fungal Agents. Principles and Practice of Infectious Diseases. 4th ed.. New York: Churchill Livingstone; 1994: 401-410
• 6 Lehmann PF. Fungal structure and morphology. Topley Wilson Med Mycol 1998; 4: 57-58
• 7 Brassart D, Woltz A, Golliard M, Neeser JR. In vitro inhibition of adhesion of Candida albicans clinical isolates to human buccal epithelial cells by Fuc alpha 1—2Gal beta-bearing complex carbohydrates. Infect Immun 1991; 59 (05) 1605-1613
• 8 Ghannoum MA, Burns GR, Elteen KA, Radwan SS. Experimental evidence for the role of lipids in adherence of Candida spp. to human buccal epithelial cells. Infect Immun 1986; 54 (01) 189-193
• 9 Douglas LJ. Surface composition and adhesion of Candida albicans. Biochem Soc Trans 1985; 13 (06) 982-984
• 10 Sobel JD, Muller G, Buckley HR. Critical role of germ tube formation in the pathogenesis of candidal vaginitis. Infect Immun 1984; 44 (03) 576-580
• 11 Saltarelli CG, Gentile KA, Mancuso SC. Lethality of Candida strains as influenced by the host. Can J Microbiol 1975; 21 (05) 648-654
• 12 Smith CB. Candidiasis: Pathogenesis, Host Resistance and Predisposing Factors. in Bodey GP, Fainstein V. Candidiasis New York: Raven Press; 1985: 53-70
• 13 Slutsky B, Buffo J, Soll DR. High-frequency switching of colony morphology in Candida albicans. Science 1985; 230 4726 666-669
• 14 Akpan A, Morgan R. Oral candidiasis. Postgrad Med J 2002; 78 (922) 455-459
• 15 Epstein JB, Pearsall NN, Truelove EL. Oral candidiasis: effects of antifungal therapy upon clinical signs and symptoms, salivary antibody, and mucosal adherence of Candida albicans. Oral Surg Oral Med Oral Pathol 1981; 51 (01) 32-36
• 16 Olsen I, Stenderup A. Clinical-mycologic diagnosis of oral yeast infections. Acta Odontol Scand 1990; 48 (01) 11-18
• 17 Silverman Jr S. Laboratory diagnosis of oral candidiasis. In Samaranayake LP, Macfarlane TW. Oral Candidosis 1st ed. Cambridge: Butterwort; 1990: 213-237
• 18 Budtz-Jörgensen E. Clinical aspects of Candida infection in denture wearers. J Am Dent Assoc 1978; 96 (03) 474-479
• 19 Epstein JB, Pearsall NN, Truelove EL. Quantitative relationships between Candida albicans in saliva and the clinical status of human subjects. J Clin Microbiol 1980; 12 (03) 475-476
• 20 Samaranayake LP. Nutritional factors and oral candidosis. J Oral Pathol 1986; 15 (02) 61-65
• 21 Cutler JE, Friedman L, Milner KC. Biological and chemical characterization of toxic substances from Candida albicans. Infect Immun 1972; 6 (04) 616-627
• 22 Sandven P. Laboratory identification and sensitivity testing of yeast isolates. Acta Odontol Scand 1990; 48 (01) 27-36
• 23 McCullough MJ, Ross BC, Reade PC. Candida albicans: a review of its history, taxonomy, epidemiology, virulence attributes, and methods of strain differentiation. Int J Oral Maxillofac Surg 1996; 25 (02) 136-144
• 24 Scully C, el-Kabir M, Samaranayake LP. Candida and oral candidosis: a review. Crit Rev Oral Biol Med 1994; 5 (02) 125-157
• 25 Singh A, Verma R, Murari A, Agrawal A. Oral candidiasis: an overview. J Oral Maxillofac Pathol 2014; 18 Suppl 1 S81-S85